A Higher Manometric Esophageal Length to Height Ratio in Achalasia Explains the Lower Prevalence of Hiatal Hernia.

Background/Aims: The evidence suggests that a shorter esophageal length (EL) in gastroesophageal reflux disease (GERD) patients is associated with the presence of hiatal hernia (HH). However, there are no reports of this association in patients with achalasia. The aim is to (1) determine the prevalence of hiatal hernia in achalasia patients, (2) compare achalasia EL with GERD patients and healthy volunteers (HV), (3) measure achalasia manometric esophageal length to height (MELH) ratio, and (4) determine if there are differences in symptoms between patients with and without hiatal hernia. Methods: This retrospective and cross-sectional study consist of 87 pre-surgical achalasia patients, 22 GERD patients, and 30 HV. High-resolution manometry (HRM), barium swallow, and upper endoscopy were performed to diagnose HH. The EL and MELH ratio were measured by HRM. Symptoms were assessed with Eckardt, Eating Assessment Tool, and GERD-health-related quality of life questionnaires. Results: The HH in GERD's prevalence was 73% vs 3% in achalasia patients (P < 0.001). Achalasia patients had a longer esophagus and a higher MELH ratio than HV and GERD patients (P < 0.001). GERD patients had a lower MELH ratio than HV (P < 0.05). EAT-10 (P < 0.0001) and Eckardt (P < 0.05) scores were higher in achalasia without HH vs HH. Conclusions: The prevalence of HH in achalasia is significantly lower than in GERD. The longer EL and the higher MELH ratio in achalasia could explain the lower prevalence of HH. Despite the low prevalence of HH in achalasia patients, the surgeon should be encouraged not to rule out HH since the risk of postoperative reflux may increase if this condition is not identified and corrected.

A new method to estimate catheter length for esophageal multichannel intraluminal impedance monitoring in children.

BACKGROUND: Multichannel intraluminal impedance combined with pH (MII-pH) is the gold standard test for diagnosing gastro-esophageal reflux disease (GERD). It provides an opportunity to study acid and non-acid GOR and temporal association between symptoms and reflux. Accurate catheter placement is essential to prevent erroneous recording of reflux events. The aims of our study were to assess the accuracy of our devised method in predicting the catheter length for MII-pH in children (Great Ormond Street Hospital (GOSH) Table) and to compare the results with Strobel and Monreau methods. METHODS: Retrospective review of all records of infants and children who underwent MII-pH studies between January to October 2014. Desired catheter position was calculated using Strobel, Monreau and GOSH formulas and compared to X ray position. KEY RESULTS: One hundred and forty-four children were included; mean age was 5.1 (±4.5) years, 73 males and 71 females. In the whole group, the correlation between desired catheter position and GOSH Table was 0.95, for Strobel was 0.84, and Monreau was 0.85. In the first group (age <3 years), the correlation was: GOSH Table 0.91, Strobel 0.56, and Monreau 0.6; in the second group (3-10 years): GOSH Table 0.78, Strobel 0.82, and Monreau 0.82; the third group (>10 years): GOSH 0.81, Strobel 0.43, and Monreau 0.43. CONCLUSIONS & INFERENCES: GOSH Table is an accurate method to estimate the insertion length of MII-pH catheters from nares to a point of approximately two vertebral bodies above the diaphragm in children. Although radiography is required to confirm final catheter position, using GOSH Table will reduce the need for repeated catheter manipulation after initial insertion and will reduce the use of a mathematically complicated formulae.

The correlation of esophageal body length with measure of external body parameters / Correlación de la longitud del cuerpo esofágico con medida de parámetros corporales externos

There is disagreement as to whether there is a correlation between esophageal body length and that of various measurable external body parameters. This length has also been noted to vary in various disease states of the upper gastrointestinal tract and among various races. To our knowledge no such study has been published amongst an African population and Kenyans in particular. The purpose of this study was to determine how the length of the esophagus correlates with various external body parameters. This was a cross-sectional observational study at the endoscopy unit of Kenyatta National Hospital (KNH). All consenting patients undergoing upper gastrointestinal endoscopy (OGD) at KNH. 76 subjects undergoing flexible esophagoscopy were evaluated. 43 were male. The mean esophageal length was 22.2 cm (SD 2.63). Males had a longer esophagus than women. The esophageal length had a negative correlation with weight of individual and body mass index. There was a positive correlation between esophageal length versus height of the individual and the sternal length. Individual's height is the parameter that best correlates with the esophageal body length.

Hay desacuerdo en cuanto a si existe una correlación entre la longitud del cuerpo esofágico y la de varios parámetros corporales externos medibles. Esta longitud se ha observado que varía en diferentes estados de enfermedades del tracto gastrointestinal superior y entre distintas razas. Según la literatura consultada, ningún estudio de este tipo se ha publicado, en particular, entre una población de África y Kenia. El propósito de este estudio fue determinar cómo la longitud del esófago se correlaciona con diversos parámetros corporales externos. Se realizó un estudio observacional y transversal en la Unidad de Endoscopía del Hospital Nacional Kenyatta (KNH). Todos los pacientes sometidos consintieron a la la endoscopía digestiva alta (OGD) en KNH. Fueron evaluados76 pacientes sometidos a endoscopía flexible. (43 eran hombres). La longitud promedio del esófago fue de 22,2 cm (DE 2,63). Los hombres tuvieron un esófago más largo que las mujeres. La longitud del esófago tuvo una correlación negativa con el peso del individuo y su índice de masa corporal. Hubo una correlación positiva entre la longitud del esófago en comparación con la altura de la persona y la longitud esternal. La altura individual es el parámetro que mejor se correlaciona con la longitud del cuerpo esofágico.

Normal Esophageal Length in Korean Children; Correlation of the Esophageal Length with Height Measured by Flexible Endoscopy / 대한소아소화기영양학회지

PURPOSE: There have been a few data about esophageal length in children and previous data are improper for application to various procedures. Because of the variability in height and weight of each the individuals especially in children, measurable external parameters are needed. METHODS: We measured distance from upper incisor to esophago-gastric junction using a flexible endoscope and compared these data with age, height and weight in 262 children who underwent upper gastrointestinal endoscopy. RESULTS: The mean age was 9.0+/-3.6 year (from 2 days to 16 year of age), mean height was 132.89+/-23.49 cm and mean length from upper incisor to esophago-gastric junction was 33.34+/-5.42 cm. Correlation between distance from upper incisor to esophago-gastric junction and height was the mostly predictable indicator of the esophageal length (Pearson correlation=0.944). We propose a formula [Esophageal length=4.419+(0.218 x height)] as a indicator of the esophageal length (p=0.000, R2=0.891). CONCLUSION: The esophageal length in children and for application to various procedures can be reliably predicted by using the height.

A study on esophageal length of the adult Chinese by endoscope / 西安交通大学学报(医学版)

Objective To investigate whether there is a correlation between the esophageal length of the adult Chinese people and their height, sitting height, sex or age. Methods The length from the upper end of esophagus to the dentate line of the cardia was measured by watching esophageal cavity with endoscope. A total of 613 cases (378 males and 235 females) were studied. Results ① The average length of esophagus was (24.8?2.1)cm for male and (22.8?1.9)cm for female. The difference between male and female was statistically significant (P

AN INITIAL STUDY ON ESOPHAEEAL LENGTH OF THE CHINES PEOPLE BY ENDOSCOPIC MEASUREMENT / 西安交通大学学报(医学版)

The lenght from incisor to dentate line of the cardia was measured by watching esophageal cavity by means of endoscope Studying a total of 644 cases (380 males and 264 females) we found ①The average length from incisor to dentate line of the cardia was 41.084?2.032 cm for male, 38.24?2.08 cm for female and the difference between male and female was statistically significant (P